Dumoulin Chantale, Tang An, Pontbriand-Drolet Stéphanie, Madill Stephanie J, Morin Mélanie
School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
Urogynecological Health and Aging Canadian Research Chair, Research Centre of the Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada.
Int Urogynecol J. 2017 Aug;28(8):1233-1239. doi: 10.1007/s00192-016-3254-7. Epub 2017 Jan 12.
The aim of this study was to determine if pelvic floor muscle (PFM) morphometry at baseline, as measured by MRI, can predict response to PFM training in women with stress or mixed urinary incontinence (UI).
This study was a prospective quasi-experimental pre-test, post-test cohort study of women with UI, aged 60 years and older. All participants completed a baseline assessment of UI severity and impact, using the 72-h bladder diary and the Incontinence Impact Questionnaire. They underwent a pelvic MRI examination to assess the PFM anatomy. Women then participated in a 12-week PFM training program. Finally, they attended a post intervention assessment of UI severity and impact. The association between morphometry and PFM training response was assessed by univariate analysis, multivariate analysis, and receiver operating characteristic (ROC) curve analysis.
The urethro-vesical junction height at rest, as measured by MRI before treatment, was associated with response to PFM training both on univariate (p ≤ 0.005) and multivariate analyses (p = 0.007). The area under the ROC curve was 0.82 (95% confidence interval [CI]: 0.67-0.96). Using a cut-off point of 11.4 mm, participants' response to PFM training was predicted with a sensitivity of 77% and a specificity of 83%. Incontinent women with a urethro-vesical junction height above this threshold were 35% more likely to respond to PFM training (OR 1.35; 95% CI: 1.08-1.67).
In older women with UI, a urethro-vesical junction height at rest of at least 11.4 mm appears to be predictive of PFM training response.
本研究的目的是确定通过MRI测量的基线盆底肌肉（PFM）形态学指标是否能够预测压力性或混合性尿失禁（UI）女性对PFM训练的反应。
本研究是一项针对60岁及以上UI女性的前瞻性准实验性前后测队列研究。所有参与者使用72小时膀胱日记和尿失禁影响问卷完成了UI严重程度和影响的基线评估。他们接受了盆腔MRI检查以评估PFM解剖结构。然后女性参与者参加了为期12周的PFM训练计划。最后，她们接受了UI严重程度和影响的干预后评估。通过单因素分析、多因素分析和受试者工作特征（ROC）曲线分析评估形态学指标与PFM训练反应之间的关联。
治疗前通过MRI测量的静息时尿道膀胱连接部高度在单因素分析（p≤0.005）和多因素分析（p = 0.007）中均与PFM训练反应相关。ROC曲线下面积为0.82（95%置信区间[CI]：0.67 - 0.96）。使用11.4毫米的截断点，预测参与者对PFM训练反应的灵敏度为77%，特异度为83%。尿道膀胱连接部高度高于此阈值的尿失禁女性对PFM训练有反应的可能性高35%（OR 1.35；95% CI：1.08 - 1.67）。
在老年UI女性中，静息时尿道膀胱连接部高度至少为11.4毫米似乎可预测PFM训练反应。
